Continuation Versus Interruption of Oral Anticoagulation During TAVI: A Systematic Review and Meta-Analysis Oral...

Patients undergoing transcatheter aortic valve implantation (TAVI) often require long-term oral anticoagulation (OAC), but it is unclear whether to continue or interrupt OAC during the procedure. This meta-analysis compares clinical outcomes of continuing versus interrupting OAC during TAVI. PubMed, Embase, and Cochrane Central databases were searched from inception to September 2024 for studies comparing continuation versus interruption of OAC in patients undergoing TAVI with an indication for OAC, including vitamin K antagonists and direct oral anticoagulants. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. Sensitivity analysis was performed using the Hartung-Knapp-Sidik-Jonkman method. Three studies were included, one randomized controlled trial and two cohort studies, with 2773 patients, of whom 1314 (47.4%) continued OAC during TAVI. At a 30-day follow-up after TAVI, there were no significant differences between groups in all-cause mortality (RR 0.74; 95% CI 0.45-1.20; p = 0.22), any bleeding (RR 1.08; 95% CI 0.81-1.43; p = 0.60), and major bleeding (RR 0.90; 95% CI 0.67-1.21; p = 0.48). However, the continued OAC group was associated with a lower stroke rate (RR 0.65; 95% CI 0.42-1.01; p = 0.053), also attested after a sensitivity analysis (RR 0.65; 95% CI 0.47-0.90; p < 0.03). In patients with an indication for OAC undergoing TAVI, uninterrupted anticoagulation is associated with similar thrombotic and hemorrhagic outcomes compared to interrupted OAC. Stroke risk was lower in the continued OAC group, with a significant reduction, as demonstrated in sensitivity analysis.